TERMINAL CHOP (5) GRADE 4 NUCLEUS скачать в хорошем качестве

TERMINAL CHOP (5) GRADE 4 NUCLEUS

Terminal Chop Introduced in the year 2015 by Rajendra Prasad, this technique is predominantly useful in mature cataracts which primarily consist of a hard nucleus and negligible epinuclear plate and very little cortex. After making a large capsulorrhexis with an intended 6 mm diameter and minimal hydro dissection to avoid stress at the fragile posterior capsule (as in mature cataracts due to mechanical distension), the following steps are taken: 1. Stabilisation of nucleus by impaling the phaco tip with a short superficial partial trench A 1mm X 1mm X1mm short trench is sculpted in the nucleus at the capsulotomy edge and the phaco tip is engaged at the distal edge of the trench beneath the capsulorrhexis margin with the tip directed towards the equator while keeping it parallel to the pupillary plane. 2. Creation of firm grip of nucleus 1.5 mm within the equator 3. Drawing the equator of nucleus to bring it within the capsulotomy margin 4. Terminal chopping manoeuvre Specially designed (Rajendra Prasad’s) angulated blunt chopper with a smooth olive tip is then gently passed around the lens equator by sliding it into the space created within the capsulotomy edge, to hook and engage the nucleus precisely to the left of the line of phaco probe (in case of a right-handed surgeon). The chopper is then drawn barely 1.5-2 mm into the thin and softer terminal edge of the nucleus to create a small full thickness nick, adjacent to the phaco tip. Force vector of 90° lateral separation is then initiated and continued until the entire nucleus is split from equator to equator, through the centre, following the natural cleavage plane through the lens fibres, resulting in two complete clean halves. Same procedure is repeated on the hemi nuclei after rotating them 90° clockwise or anti-clockwise and making multiple fragments, depending on the hardness of the nucleus and emulsifying and aspirating them thereafter.